Lyme Carditis and Pacemaker Removal: When Is It Possible?

High-degree heart block led to pacemaker placement
Both patients were later treated for Lyme disease
Pacemakers were successfully removed after recovery

In their study, “Pacemaker Explantation in Patients With Lyme Carditis,” Wamboldt and colleagues describe two cases where permanent pacemakers were later removed following treatment for Lyme carditis.

These cases highlight the importance of considering Lyme carditis in the differential diagnosis of high-degree atrioventricular (AV) block—especially in patients without a clear cardiac history.

Lyme Carditis and Heart Block

Lyme carditis can affect the electrical conduction system of the heart, most commonly causing AV block. These cardiac symptoms are part of a broader pattern described in our Lyme disease symptoms guide.

Case #1: Complete Heart Block

A 48-year-old woman presented with shortness of breath and dizziness due to complete heart block. She was transferred for pacemaker implantation due to symptomatic bradycardia.

She reported a non-specific rash 3 months earlier. Lyme disease testing was positive.

Following antibiotic treatment and recovery of cardiac conduction, her pacemaker was successfully removed.

Case #2: Symptomatic Pauses and Atrial Fibrillation

A 58-year-old man presented with dizziness, syncope, headache, and myalgia. His electrocardiogram showed atrial fibrillation with a slow ventricular response.

During hospitalization, he experienced symptomatic pauses lasting 4 to 10 seconds and underwent pacemaker implantation.

Lyme disease testing was also positive, and he was treated successfully with antibiotics.

Temporary vs. Permanent Pacemakers

Patients with Lyme carditis and conduction abnormalities are typically managed with temporary pacing when needed.

In these cases, however, permanent pacemakers were initially placed. After treatment, both patients regained normal conduction and no longer required pacing support.

Successful Pacemaker Removal

At follow-up, both patients demonstrated stable cardiac conduction. Exercise stress testing showed maintained 1:1 conduction at heart rates above 120 beats per minute.

Their pacemakers were removed successfully within the first year.

Early removal is important, as device extraction becomes more difficult over time due to fibrotic changes.

Why This Matters

These cases demonstrate that some patients with Lyme carditis may recover fully with antibiotic treatment, potentially avoiding long-term device dependency.

They also reinforce findings discussed in our Lyme carditis progression overview, where conduction abnormalities can develop—and resolve—quickly.

In some cases, early recognition may even help avoid pacemaker placement altogether, as explored in our pacemaker avoidance in Lyme carditis discussion.

Careful follow-up and reassessment of cardiac conduction are essential in patients treated for Lyme carditis.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention